Sequential occurrence of toxic nodular goiter followed by Graves' disease

To present the first case of Graves' disease occurring after toxic nodular goiter in a patient who had not received radioiodine therapy.

We describe the clinical, laboratory, and radiologic findings in a 65-year-old woman with toxic nodular goiter followed by Graves' disease and review related reports in the literature.

Although isolated case reports have documented the sequential occurrence of toxic nodular goiter or toxic adenoma and Graves' disease, no definite connection currently exists between these two types of hyperthyroidism. In cases previously described, Graves' disease appeared after the use of radioiodine for the treatment of the toxic nodular goiter. In our current patient, toxic nodular goiter was treated surgically, followed by the occurrence of Graves' disease 3 years later.

This is the first published case of sequential toxic nodular goiter and Graves' disease in which radioiodine was not used for treatment of the goiter and thus cannot be implicated as the inciting event for the subsequent development of Graves' disease.